Adapted IPS Supported Employment for Transition Age Youth

Presented at the 26th Annual Children’s Mental Health Research & Policy Conference

March 4, 2013

The Transitions RTC aims to improve the supports for youth and young adults, ages 14-30, with serious mental health conditions who are trying to successfully complete their schooling and training and move into rewarding work lives. We are located at the University of Massachusetts Medical School, Worcester, MA, Department of Psychiatry, Center for Mental Health Services Research. Visit us at:

http://labs.umassmed.edu/transitionsRTC/index.htm

The contents of this presentation were developed with funding from the US Department of Education, National Institute on Disability and Rehabilitation Research, and the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (NIDRR grant H133B090018). Additional funding provided by UMass Medical School’s Commonwealth Medicine division. The content of this presentation does not necessarily reflect the views of the funding agencies and you should not assume endorsement by the Federal Government.

Acknowledgements

• Change is the only constant • Adaptability is key • Innovation is continuous & Messy • Goal today- learn a about an ongoing change

process

Note About Terminology

• Transition-age youth (TAY) • Employment specialist (SE specialist) • Education specialist (SEd specialist)

Overview, Principles and Practice Guidelines of Adapted IPS SE/SED Model

Marc Fagan, PsyD Susan Kaiser, MPH

Thresholds Young Adult Program (YAP)

• 16-21 y/o • Residential & Transitional Living • Community Based • Founded in TIP Principles • Transition Cliff to a Slope

Midwest Study-Wave 2 Thresholds YAP-FY12

8% Hospitalized 37% Hospitalized

29% Received Psychological Counseling

100% Received Psychological Counseling

33% Met Criteria for SMC 100% Met Criteria for SMC

24%

51%

18%

3% 5%

Schizophrenia/Schizoaffective

Bipolar/Bipolar NOS

MDD/other Affective

PTSD

Other

34%

14% 19%

10%

6%

16%

PTSDADHDNoneConduct/ODDSubstanceOther

Primary Diagnoses for YAP Members, FY12 (N=108)

Secondary Diagnoses for YAP Members, FY12 (N=108)

Midwest Study-Wave 2 N=282 IL Sample

Thresholds YAP-FY12 N=108

8% Hospitalized 37% Hospitalized

29% Received Psychological Counseling 100% Received Psychological Counseling

33% Meet criteria for SMC 100% Meet Criteria for SMC

33% Had Job Starts 25% Had Job Starts in FY10

Individual Placement and Support (IPS)

TIP Informed Substitute Care Program

Community based

Place and Train TAY choice

Futures focus Coaching

Tensions

Generalists vs. specialists

Focus on Education

Job Starts vs. job tenure (The nature of Discovery)

The REAL Match

Nuechterlein Study, 2009 Umass Learning and Working Supported Education Peer Mentors

Identified Problem(s)

Synthesized Results

Specified program Model

Specified Program Guidelines

Process of Specifying Practice Guidelines for Adapted IPS Model

• Conducted literature review/ gathered resources • Created a guiding coalition

• Defined model by developing 10 practice principles and a 29-item fidelity scale

Lesson Learned: Youth voice should be explicit in all stages of program development—especially in conceptual stages. Quick Tip: Consider convening a youth consumer advisory committee or including consumer(s) in all stages of program development.

Adapted IPS SE/SEd Model Principles • Attention to consumer preferences • Time unlimited supports • Rapid search • Integration with mental health treatment • Systematic job development

Same

• Zero exclusion is the goal • Competitive employment, paid internships, and

mainstream educational activities are the goal • Benefits and financial aid planning is important

Modified

• Exposure to the worlds of work, career and education.

• Youth voice and leadership. Added

Adapted IPS SE/SED Fidelity Scale

• Staffing, organization and service components • 29-item scale • Each item reflects specific elements of the program

model • 5-point behaviorally anchored scale • Total scores range from 1-5

Adapted Guidelines

• Exclusive focus on employment and education

• Vocational/ Educational Generalists

• Peer Mentors

Lesson Learned: Role clarity and division of responsibility is key to successful implementation . SE/SED staff + Peers

Adapted Guidelines

• Integration with youth-specific mental health services

• Confidence and knowledge building activities • Competitive Jobs/Internships/Mainstream

Educational programs • Academic accommodations

Protocol for Administering Fidelity Scale

• One day site visit • 2 trained fidelity assessors • Detailed protocol • Interviews- vocational program leader, two or more

employment specialists, clients • Observation- team meeting, community contact with

employers • Chart Review

Scoresheet

Thresholds YAP Fidelity Scores

Fidelity as a Measure of Feasibility • Results of 2011 and 2012 fidelity assessments

indicate model can be feasibly implemented. • Maintained high fidelity over the course of the

12 month evaluation period • Improved scores over time- increased 10% Total Fidelity Score Level of Fidelity

>4 High Fidelity

3.0 – 4.0 Moderate Fidelity

< 3.0 Low Fidelity